Are There Any Side Effects to Taking Creatine?

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

The Society for Sarcopenia, Cachexia, and Wasting Disease convened an expert panel that, despite the lack of long-term trials, suggested creatine be used for the management of age-related muscle loss––also known as sarcopenia. Are there any creatine side effects? Well, if one can extrapolate from mice, one side effect may be longevity. The average healthy lifespan of creatine-fed mice was found to be nine percent more than control mice, and they performed better on neurobehavioral tests, especially improved memory skills. But is taking creatine safe?

One can take a bit of comfort in the fact that it’s one of the world’s best-selling dietary supplements, with literally billions of servings taken, and the only consistently reported side effect has been weight gain, presumed to be from water retention. The only serious side effects appear to be among those with pre-existing kidney diseases taking whopping doses of like 20 grams a day for weeks.

The bottom line, according to the European Food Safety Authority, is that doses of up to three grams a day are unlikely to pose any risk “provided high purity creatine is used.” Dietary supplements are not regulated by the FDA, and may not actually contain what’s on the label or, in the case of creatine, may be tainted with contaminants generated during the industrial production process. When researchers looked at 33 samples of creatine supplements made in the U.S. and Europe, they all did actually contain creatine. That’s good. But half exceeded the maximum level recommended by food safety authorities for at least one contaminant. The researchers recommend that consumers choose products from producers that ensure the “highest quality control.” But that’s easier said than done.

One third-party supplement testing outfit that tested for impurities chose BulkSupplements brand as their top pick, which also happened to be the cheapest, at about 10 cents per daily three-gram serving, which is a level teaspoon. What about just getting it from meat? You could get those three grams of creatine eating about five steaks a day, since cooking destroys about 20 percent. But the heat reacts with the creatine and amino acids in meat to create carcinogenic heterocyclic amines––one of the reasons meat is considered to be cancer-causing. A separate safety concern was raised that creatine in supplement form could potentially form a different carcinogen, known as N-nitrososarcosine, when it hit the acid bath of the stomach. But when actually put to the test, this does not appear to be a problem.

Some have argued caution for creatine use among those with kidney issues. This concern appears to derive in part from a misinterpretation of laboratory data. The blood levels of a different compound—creatinine—is used as a marker of kidney function. It is a muscle metabolism waste product that is regularly cleared out by well-functioning kidneys. So, if your levels rise, maybe your kidneys aren’t doing so good.

But where does creatinine come from? The breakdown of creatine. So, if you take extra creatine, your creatinine levels in your blood could rise, giving the false impression that your kidneys are malfunctioning. But instead, you’re just making more, rather than clearing less. For patients who take creatine, doctors can consider other kidney function tests, such as blood levels of cystatin C levels, a waste product that is more independent of dietary intervention. So, tell your healthcare professional if you start creatine. Overall, creatine supplementation appears to be safe for the kidneys, but the longest study to date is less than three years. So, true long-term studies are lacking.

Please consider volunteering to help out on the site.

• Korzun WJ. Oral creatine supplements lower plasma homocysteine concentrations in humans. Clin Lab Sci. 2004;17(2):102-106.
• Steenge GR, Verhoef P, Greenhaff PL. The effect of creatine and resistance training on plasma homocysteine concentration in healthy volunteers. Arch Intern Med. 2001;161(11):1455-1456.
• Butts J, Jacobs B, Silvis M. Creatine use in sports. Sports Health. 2018;10(1):31-34.
• Levels of creatine, organic contaminants and heavy metals in creatine dietary supplements. Food Chemistry. 2011;126(3):1232-1238.
• Bizzarini E, De Angelis L. Is the use of oral creatine supplementation safe? J Sports Med Phys Fitness. 2004;44(4):411-416.
• Kreider RB, Kalman DS, Antonio J, et al. International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine. J Int Soc Sports Nutr. 2017;14(1):18.
• Opinion of the Scientific Panel on food additives, flavourings, processing aids and materials in contact with food (Afc) on a request from the Commission related to creatine monohydrate for use in foods for particular nutritional uses. EFSA Journal. 2004;36:1-6.
• Archer MC. Creatine: a safety concern. Toxicol Lett. 2004;152(3):275.
• Derave W, Vanden Eede E, Hespel P, Carmella SG, Hecht SS. Oral creatine supplementation in humans does not elevate urinary excretion of the carcinogen N-nitrososarcosine. Nutrition. 2006;22(3):332-333.
• Sumien N, Shetty RA, Gonzales EB. Creatine, creatine kinase, and aging. Subcell Biochem. 2018;90:145-168.
• Bender A, Beckers J, Schneider I, et al. Creatine improves health and survival of mice. Neurobiol Aging. 2008;29(9):1404-1411.
• Antonio J, Candow DG, Forbes SC, et al. Common questions and misconceptions about creatine supplementation: what does the scientific evidence really show? J Int Soc Sports Nutr. 2021;18(1):13.
• Morley JE, Argiles JM, Evans WJ, et al. Nutritional recommendations for the management of sarcopenia. J Am Med Dir Assoc. 2010;11(6):391-396.
• de Souza E Silva A, Pertille A, Reis Barbosa CG, et al. Effects of creatine supplementation on renal function: a systematic review and meta-analysis. J Ren Nutr. 2019;29(6):480-489.
• Morley JE. Nutritional supplementation and sarcopenia: the evidence grows. J Am Med Dir Assoc. 2015;16(9):717-719.
• Murty MSN, Sharma UK, Pandey VB, Kankare SB. Serum cystatin C as a marker of renal function in detection of early acute kidney injury. Indian J Nephrol. 2013;23(3):180-183.
• Muscle & workout supplements review (creatine and branched-chain amino acids). ConsumerLab. Mar 2023.
• Overvik E, Kleman M, Berg I, Gustafsson JA. Influence of creatine, amino acids and water on the formation of the mutagenic heterocyclic amines found in cooked meat. Carcinogenesis. 1989;10(12):2293-2301.
• Purchas RW, Busboom JR, Wilkinson BHP. Changes in the forms of iron and in concentrations of taurine, carnosine, coenzyme Q(10), and creatine in beef longissimus muscle with cooking and simulated stomach and duodenal digestion. Meat Sci. 2006;74(3):443-449.
• IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Red Meat and Processed Meat. Lyon (FR): IARC; 2018.
• Hultman E, Söderlund K, Timmons JA, Cederblad G, Greenhaff PL. Muscle creatine loading in men. J Appl Physiol (1985). 1996;81(1):232-237.

Motion graphics by Avo Media

• animal products
• brain health
• creatine
• Europe
• FDA
• kidney disease
• kidney function
• meat
• muscle health
• muscle strength
• supplements